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Laparoscopic Colon Surgery

Laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery.

Conventional Colon Surgery

Each year, more than 600,000 surgical procedures are performed in the United States to treat a number of colon diseases. Although surgery is not always a cure, it is often the best way to stop the spread of disease and alleviate pain and discomfort.

Patients undergoing colon surgery often face a long and difficult recovery because the traditional "open" procedures are highly invasive. In most cases, surgeons are required to make a long incision. Surgery results in an average hospital stay of 5-8 days and usually 6 weeks of recovery.

What is the Colon?

The colon is the large intestine; it is the lower part of your digestive tract. The intestine is a long, tubular organ consisting of the small intestine, the colon (large intestine) and the rectum, which is the last part of the colon. After food is swallowed, it begins to be digested in the stomach and then empties into the small intestine, where the nutritional part of the food is absorbed. The remaining waste moves through the colon to the rectum and is expelled from the body. The colon and rectum absorb water and hold the waste until you are ready to expel it.

What is laparoscopic colon resection?

In most laparoscopic colon resections, surgeons operate through 4 or 5 small openings (each about a ½ inch) while watching an enlarged image of the patient's internal organs on a television monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure.

Who is a candidate?

Although laparoscopic colon resection has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic colon resection in consultation with your primary care physician to find out if the technique is appropriate for you.

How to proceed

Advance tests...

Most diseases of the colon are diagnosed with one of two tests: a colonoscopy or Barium Enema. These tests allow the surgeon to look inside of the colon. Sometimes a CT scan of the abdomen will be necessary. Prior to the operation, other blood tests, electrocardiogram (EKG) or a chest x-ray might be required.

Preparing for surgery...

• It is acceptable to shower the night before or morning of the operation.
• The rectum and colon must be completely empty before surgery. Usually, the patient must drink a large volume (gallon) of a special cleansing solution. (S)He may be on several days of clear liquids, laxatives and enemas prior to the operation.
• Antibiotics by mouth are commonly prescribed. Your surgeon or his/her staff will give you instructions regarding the cleansing routine to be used.
• Follow your surgeon's instructions carefully. If you are unable to take the preparation or the antibiotics, contact your surgeon.
• If you do not complete the preparation, it may be unsafe to undergo the surgery and it may have to be rescheduled.
• Most medications can be continued as usual. Ask your surgeon if you may continue yours. Drugs such as aspirin, anti-inflammatory, blood thinners and insulin are examples of medications which may have to be decreased or temporarily stopped.

How is the surgery performed?

"Laparoscopic" and "open" colon surgery simply describe the techniques a surgeon uses to gain access to the internal surgery site.

Most laparoscopic colon procedures start the same way. Using a canula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the canula, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Several other canulas are inserted to allow the surgeon to work inside and remove part of the colon. The entire procedure may be completed through the canulas or by lengthening one of the small canula incisions.

Advantages

Results may vary depending upon the type of procedure and patient's overall condition. Common advantages are:

• Less postoperative pain
• May shorten hospital stay
• May result in a faster return to solid-food diet
• May result in a quicker return of bowel function
• Quicker return to normal activity
• Better cosmetic results

What complications may occur?

As with any operation, there is the risk of a complication. However, the risk of one of these complications occurring is no higher than if the operation was done with the open technique.

Slight risk:

• Bleeding or infection (present with any operation)

Even smaller risk:

• A leak where the colon was connected back together.
• Injury to adjacent organs such as the small intestine, ureter, or bladder
• Blood clots to the lungs.

It is important for you to recognize the early signs of possible complications. Contact your surgeon if you notice severe abdominal pain, fevers, chills or rectal bleeding.

Who is not a candidate?

In a small number of patients the laparoscopic method does not work effectively. Factors that may increase the possibility of choosing or converting to the "open" procedure may include:

• obesity
• a history of prior abdominal surgery causing dense scar tissue
• inability to visualize organs
• bleeding problems during the operation

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open (conventional) procedure is strictly based on patient safety.

What can I expect after the surgery?

After the operation, it is important to follow your doctor's instructions. Although many people feel better in just a few days, remember that your body needs time to heal.

• You are encouraged to be out of bed the day after surgery and to walk. This will help diminish the soreness in your muscles.
• You will probably be able to get back to most of your normal activities in one to two weeks time. These activities include showering, driving, walking up stairs, work and sexual intercourse.
• If you have prolonged soreness, or drainage from any of your incisions, and are getting no relief from the prescribed pain medication, you should notify your surgeon.
• You should call and schedule a follow-up appointment within 2 weeks after your operation.